Administration of Naloxone in a Home or Community Setting: A Rapid Qualitative Review

Key Message

This review presents a thematic analysis of the results of 11 included studies and reveals both the promise and the challenges of administering naloxone in the home and community setting. Experiences emerged as different across groups who typically administer naloxone, including Emergency Medical Service (EMS) workers, police, and peer responders. Naloxone can save lives, and was therefore viewed as consistently rewarding for responders. An overdose event can be a pivotal moment in the lives of both opioid victims and peer responders. Some explained that they initiated harm reduction activities subsequent to the overdose event, suggesting an impact on people’s lives beyond the act of administering naloxone. Uniquely, police officers felt they were well positioned to administer naloxone because they were often the first to arrive at the scene of an overdose. Furthermore, they thought it could contribute to improved relationships within the community.EMS workers at times described frustration and burnout when they were called upon to revive the same patient on more than one occasion. The view that opioid users were less deserving than some other emergency victims was expressed by some. The use of opioids was viewed as a 'choice' in these cases and therefore the emergency was viewed as self-inflicted. These results suggest that EMS workers may benefit from an increased understanding of mental health and addictions, which may help reduce stigmatizing attitudes towards opioid users and overdose victims.The experience of administering naloxone can be challenging because it can throw the overdose victim into withdrawal, which can lead to angry, violent confrontations with those around them. EMS workers and peer responders who were experienced with naloxone administration described that they were able to titrate doses so that the survivor was revived but not sufficiently awake to be angry or violent. This was a particularly important strategy when transportation times to the hospital were long, for example in rural settings. This was a strategy that was also viewed as favourable for the victim, as a sudden withdrawal can lead to extreme urges to return to using opioids immediately.Peer responders have the advantage of often being present when an overdose occurs; however, they noted that recognizing an overdose event is not always straightforward, and often occurs in a context of anxiety and panic. Some described a hesitancy to call 911 as this may jeopardize their housing status, and introduce fear of prosecution. Peer responders described emotional exhaustion when they were called on to intervene frequently and when they had a close relationship with an opioid victim. They explained that sometimes their intervention led to altered interpersonal relationships with the victim, which could be negative or positive.The results reveal that peer responders’ sense of competency appears to be strengthened when they are praised by paramedics, suggesting that paramedics can play an important role in terms of their social interaction with others, and not just in terms of their technical competencies.Several participants across the included studies expressed frustration that administering naloxone does address the root cause of the opioid crisis in their communities.